Is Endoscopic Ultrasonography Indispensable in Assessing the Appropriateness of Endoscopic Resection for Gastric Cancer?

Hizawa, Kazuoki; Iwai, Kunimitsu; Esaki, Mitsuru; Matsumoto, Takayuki; Suekane, Hiroshi; Iida, Mitsuo

doi:10.1055/s-2002-35851

Cited by 76 publications

(84 citation statements)

References 7 publications

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“…However, even recent studies have reported widely varying diagnostic accuracies of 67-90 % when determining the depth of invasion using EUS, making it difficult to view the method as sufficiently reliable [9][10][11][12][13][14]. Furthermore, its diagnostic ability is similar to that of CE alone [15][16][17], and a number of studies have stated that EUS is unsuitable as a routine investigation for determining the depth of invasion by EGCs [15]. In recent years, there have been some promising reports regarding the determination of invasion depth using new modalities such as infrared endoscopy [18] and magnifying endoscopy with narrow-band imaging [19], but these are yet to produce consistently reliable results.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

et al. 2016

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Background and aim The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 lm) and invasive submucosal (SM2: depth of 500 lm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The ''non-extension sign'' relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. Methods This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. Results We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). Conclusion The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

et al. 2016

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“…This contributes to disease estimation, selection of surgical procedure and prognosis assessment (Willis et al 2000;Kwee and Kwee 2007). With constant improvements in EUS, its superiority in T and N staging of gastric cancer has been demonstrated (Greenberg et al 1994;Hizawa et al 2002;Akashi et al 2006). However, due to the limitation of the probe frequency of endoluminal sonography and the penetration depth of the ultrasonic beam, its inferiority in M staging of gastric cancer (i.e., its incapacity to accurately predict the distant metastasis of gastric cancer) is also shown (Ziegler et al 1993;Bhandari et al 2004;Chen et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Zheng

Zhu

et al. 2012

Tohoku J. Exp. Med.

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Accurate staging of gastric cancer is helpful to determine the most appropriate therapy, but no staging modality has been accepted as the standard. Objective is to evaluate the usefulness of endoscopic ultrasonograph (EUS) combined with position emission tomography and computed tomograph (PET-CT) in gastric cancer staging. A total of 124 patients confirmed with gastric cancer were subjected to staging with EUS and PET-CT scanning. The detection rate of primary tumor was 99.2% by combination use of two modalities and 97.6% by EUS alone ( p = 0.6219), but the detection rate was 90.3% (112 of 124) by PET-CT alone (compared with the combination, p = 0.0027; compared with EUS alone, p = 0.0299). The locoregional lymph node invasion was identified in 84/124 (67.7%) by combined PET-CT and EUS, which was obviously higher than that with EUS (52.4%) or PET-CT (43.5%) alone ( p = 0.0194 and p = 0.0002, respectively). There was no statistical difference in identification of celiac axis lymph node metastasis among three methods, but the combined examination or PET-CT alone was more effective than EUS alone in the detection of distant metastases (all p < 0.01). Furthermore, the combined EUS and PET-CT was more optimal than using EUS or PET-CT alone in the accurate T and N staging and the effect on change of treatment. The present study indicates that the combination of EUS and PET-CT is an ideal modality in the preoperative staging of gastric cancer and it provides beneficial guidance for the treatment of gastric cancer.

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“…To date, EUS imaging can be performed with echoendoscopes or with the use of ultrasound catheters or 'miniature probes' which are passed through standard endoscopes. These miniature probes can provide ultra-high-frequency imaging (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), compared to echoendoscopes (5-12 MHz). Higher frequency yields higher resolution of the tumor at the expense of depth of penetration, thus limiting nodal examination [1,2]; thus, a higher frequency probe may provide better evaluation of a T1/T2 cancer, while a lower frequency probe may be more accurate in predicting nodal involvement.…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

“…Fifteen studies [7, 17, 19, 20, 22-24, 26, 29-32, 34-36] used combinations of frequencies of B12 MHz and six studies [18,25,27,28,33,37] used combinations of frequencies ranging from 5 to 20 MHz. It was not feasible to construct a 2 9 2 table to investigate transducer frequencies as source of heterogeneity.…”

Section: Eus Examinationmentioning

confidence: 99%

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

et al. 2012

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Background Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer. Methods Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Metaanalysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed. Results Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively). Conclusion EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.

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Is Endoscopic Ultrasonography Indispensable in Assessing the Appropriateness of Endoscopic Resection for Gastric Cancer?

Abstract: Endoscopic resection is indicated in intramucosal gastric cancer lesions showing differentiated histology, no ulcer fibrosis and a diameter of less than 2 cm. EUS may additionally be used for further evaluation in these patients.

Cited by 76 publications

References 7 publications

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

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